• Lise E Nigrovic, Lois K Lee, John Hoyle, Rachel M Stanley, Marc H Gorelick, Michelle Miskin, Shireen M Atabaki, Peter S Dayan, James F Holmes, Nathan Kuppermann, and Traumatic Brain Injury (TBI) Working Group of Pediatric Emergency Care Applied Research Network (PECARN).
• Division of Emergency Medicine, Children's Hospital, Boston, 300 Longwood Ave, Boston, MA 02115, USA. lise.nigrovic@childrens.harvard.edu
• Arch Pediatr Adolesc Med. 2012 Apr 1;166(4):356-61.

ObjectiveTo determine the prevalence of clinically important traumatic brain injuries (TBIs) with severe injury mechanisms in children with minor blunt head trauma but with no other risk factors from the Pediatric Emergency Care Applied Research Network (PECARN) TBI prediction rules (defined as isolated severe injury mechanisms).DesignSecondary analysis of a large prospective observational cohort study.SettingTwenty-five emergency departments participating in the PECARN.PatientsChildren with minor blunt head trauma and Glasgow Coma Scale scores of at least 14.InterventionTreating clinicians completed a structured data form that included injury mechanism (severity categories defined a priori).Main Outcome MeasuresClinically important TBIs were defined as intracranial injuries resulting in death, neurosurgical intervention, intubation for more than 24 hours, or hospital admission for at least 2 nights. We investigated the rate of clinically important TBIs in children with either severe injury mechanisms or isolated severe injury mechanisms.ResultsOf the 42,412 patients enrolled in the overall study, 42,099 (99%) had injury mechanisms recorded, and their data were included for analysis. Of all study patients, 5869 (14%) had severe injury mechanisms, and 3302 (8%) had isolated severe injury mechanisms. Overall, 367 children had clinically important TBIs (0.9%; 95% CI, 0.8%-1.0%). Of the 1327 children younger than 2 years with isolated severe injury mechanisms, 4 (0.3%; 95% CI, 0.1%-0.8%) had clinically important TBIs, as did 12 of the 1975 children 2 years or older (0.6%; 95% CI, 0.3%-1.1%).ConclusionChildren with isolated severe injury mechanisms are at low risk of clinically important TBI, and many do not require emergent neuroimaging.

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